Comparison of a Community Based Tai Chi Program and a Home Exercise Program on Improvement in Balance and Gait in People with Multiple Sclerosis

Background: Multiple sclerosis (MS) is a chronic, progressive autoimmune disorder that affects the Central Nervous System (CNS) with roughly 2.3 million individuals diagnosed worldwide. Common symptoms include fatigue, weakness, balance deficit and unsteady gait. Impaired balance has been identified is as many as 75% of individuals with MS throughout the course of the disease. Balance deficits in people with MS are associated with increased fall risk which can lead to further disability.

Objectives: Compare a community based Tai Chi program to a home exercise program (HEP) and their effectiveness on improving balance, gait and fatigue in people with Multiple Sclerosis

Methods: Pre and post-testing included the Berg Balance Scale (BBS), MiniBEST,Timed Up and Go (TUG), Dynamic Gait Index (DGI), Activity-specific Balance Confidence Scale (ABC), and Fatigue Severity Scale (FSS). Thirty-three individuals were recruited to participate in the Tai Chi portion of the study, and 25 completed the study. The Tai Chi class consisted of 6-Forms which could be done in sitting or standing. The class was one hour, two times per week for six weeks. Thirty-three individuals were recruited for the home exercise program part of the study, and 25 completed the study. The HEP consisted of seven balance exercises, taught following the pre-testing session. Written and video instruction was provided. The frequency of the HEP was three times per week for eight weeks. Participants were contacted at four weeks to provide guidance and to monitor adherence.

Results: Within group analysis identified that the Tai chi and HEP groups showed statistically significant (p < .05) improvements in the BBS, MiniBEST, TUG, DGI, and the ABC. Participants in the Tai Chi group improved significantly more on TUG (M = -3.30, SD = 5.52) compared to HEP group (M = -.39, SD = 2.34), p = .018. Participants in the HEP group improved significantly more on ABC (M = 9.76, SD = 8.32) compared to Tai Chi group (M = 3.95, SD = 8.97), p = .002.  Independent samples t-test revealed that participants in the Tai Chi group improved significantly more on FSS (M = -8.60, SD = 14.99) compared to HEP group (M = -1.68, SD = 8.29), p = .049. 

Conclusions: HEP group improved significantly more on the ABC which may be due to this group being younger and self-motivated to perform the HEP. Tai Chi group improved significantly more on the TUG, which may be credited to Tai Chi class including standing and weight shifting activities. The Tai Chi group improved more on the FSS (independent samples t-test) possible because the class was demanding which might lead to decreased perception of fatigue and taught in a group format where participants might receive psychological benefit from the group. Both interventions demonstrated improvements in all outcome measures; however, the HEP group showed to have superior improvements on the ABC compared to Tai Chi group, while Tai Chi group improved more on TUG and FSS.